Search Results (160)

Background: Intermediate care units face growing complexity due to aging populations and chronic illnesses. Non-technical skills such as empathy and communication are crucial for quality care. We aimed to examine the relationship between communication skills, self-efficacy, and sense of coherence among intermediate care nurses. Methods: We conducted an observational, cross-sectional study with 60 intermediate care nurses from three units in a Catalan hospital, Spain. Participants engaged in high-fidelity simulation using geriatric end-of-life scenarios with an ultra-realistic manikin representing a geriatric patient at the end of life. NTSs were measured using validated tools: the Health Professionals Communication Skills Scale (HP-CSS), the General Self-Efficacy Scale, and the Sense of Coherence Questionnaire (OLQ-13). Sessions followed INACSL standards, including prebriefing, simulation, and debriefing phases. Results: Post-simulation outcomes revealed significant gains in interpersonal competencies, with men reporting higher assertiveness (p = 0.015) and greater satisfaction with both the simulation experience (p = 0.003) and the instructor (p = 0.008), underscoring gender-related perceptions in immersive training. Conclusions: Ultra-realistic clinical simulation is effective in enhancing NTS among intermediate care nurses, contributing to improved care quality and clearer professional profiles in geriatric nursing. Full article

Biomonitoring often yields normal results in patients who report environmental sensitivities, such as in multiple chemical sensitivity. This study examined whether biomonitoring results influence disease attribution and perception. Patients over 18 presenting for the first time to the University Environmental Medicine Outpatient Clinic in Freiburg with suspected complaints linked to heavy metals, wood preservatives, pesticides, solvents, or mold spores were included. Illness perceptions were assessed before and after biomonitoring using the Illness Perception Questionnaire (IPQ-R). Of 358 patients, 51 met inclusion criteria; 3 showed relevant findings, and 15 did not attribute their symptoms to environmental causes at baseline. The remaining 33 patients were analyzed. After receiving a normal biomonitoring result, only seven patients (21%) altered their illness attribution. These individuals also reported milder perceived consequences, less personal control over the illness, and showed lower levels of somatization and compulsiveness than those who maintained their original attribution. Most patients remained convinced of an environmental cause despite unremarkable findings. This suggests that a substantial subset of patients is strongly attached to an environmental explanation for their symptoms, with stable attribution linked to higher psychological symptom burden and a belief in personal control over the illness. Full article

Background/Objectives: Adolescents with chronic physical health conditions (CHCs) use specific coping strategies to respond to condition-related stressors. However, most studies of CHC-related stress and coping focus on a single condition. The objective of this study was to measure CHC-related stress and identify associated coping strategies in adolescents with a variety of CHCs. A secondary objective was to examine the relationship between CHC-related stress, coping strategies, health-related quality of life, and perceived severity of chronic illness. Methods: Teens (n = 38, 68.42% female, mean age 17.9 years) with CHCs completed the Responses to Stress Questionnaire (RSQ) for CHC-related stress, the PedsQL to assess health-related quality of life, and the Perceptions of the Severity of Chronic Illness (PSCI) measure. The most frequently reported conditions were asthma, food allergies, and multiple conditions. We used fuzzy cluster analysis to identify two clusters, high stress and low stress, based on ratings of CHC-related stressors. Relationships between coping strategies and the PedsQL and PSCI, and between the PSCI and PedsQL, were assessed using Pearson partial correlations. Relationships between the PSCI, PedsQL, and coping strategies for the two clusters were assessed using adjusted mean differences. We adjusted for multiple comparisons by controlling the false discovery rate. Significance was set at p < 0.05. Results: Teens were most likely to use secondary control engagement coping and involuntary engagement to respond to CHC-related stressors. Teens in the two clusters differed on health-related quality of life but not coping strategies or perceived condition severity. CHC diagnosis category was associated with cluster membership. Conclusions: This exploratory study highlighted relationships among quality of life, coping strategies, and CHC diagnosis category that should be explored in future studies. Improved understanding of CHC-related stress and coping strategies in teens with CHCs could have an impact on their quality of life and well-being. Full article

Background/Objectives: Globally, one in eight people live with a mental disorder, with depression being a leading cause of disability. This study aimed to identify sociodemographic factors associated with public belief and perception of mental disorders among adults in Poland. Methods: A cross-sectional study with a self-prepared questionnaire (5-point Likert scale) was administered to a nationally representative quota sample of 1114 Polish adults (March 2025). The computer-assisted web interview (CAWI) method was applied. Results: A cross-sectional survey of 1114 adults found that 23.2% had visited psychiatrists, 15.9% psychotherapists, and 21.1% reported a family history of mental disorders. Most respondents (73.8%) believed employers are reluctant to hire individuals with mental disorders, and 53.8% perceived discrimination. Additionally, 19.4% thought mental health patients receive lower-quality care than those with physical illnesses like diabetes. Respondents from large cities (≥500,000 residents, aOR: 1.67; 95%CI: 1.11–2.51; p = 0.01), with higher education (aOR: 1.62; 95%CI: 1.26–2.07; p < 0.001), or a family history of mental disorders (p < 0.05) were more likely to hold this view. Higher education (aOR: 1.47; 95%CI: 1.11–1.94; p = 0.01), good economic status (aOR: 1.60; 1.06–2.40; p = 0.02), and personal psychiatric experience (aOR: 1.89; 95%CI: 1.24–2.87; p = 0.003) increased belief in treatment effectiveness. Males (aOR: 1.88; 95%CI: 1.36–2.61; p < 0.001) and medium-city residents (aOR: 1.82; 95%CI: 1.01–3.27; p = 0.04) more often perceived mental disorders as a sign of weakness, while women (aOR: 1.74; 95%CI: 1.36–2.22; p < 0.001) and those with affected relatives (p < 0.05) more frequently reported discrimination. Older respondents (p < 0.05), those with higher education (aOR: 1.65), and individuals with a family history of mental disorders (p < 0.05) were more likely to state that employers fear hiring people with psychiatric conditions. Conclusions: These findings underscore the need for public health interventions to reduce stigma, improve awareness, and address misconceptions about mental disorders in Poland. Full article

Background/Objectives: The COVID-19 pandemic exposed critical vulnerabilities in healthcare systems, especially in ensuring continuity of care for patients with chronic diseases. Rehabilitation services, essential for recovery following SARS-CoV-2 infection, were among the most disrupted. This exploratory study aimed to assess Romanian patients’ perceptions of the accessibility and quality of post-COVID-19 rehabilitation services, focusing on individuals with chronic conditions. Methods: This exploratory cross-sectional study was conducted over a 12-month period in 2024. Data were collected from 76 adult patients diagnosed with at least one chronic condition (hypertension, diabetes mellitus, ischemic heart disease, cancer, or chronic obstructive pulmonary disease) and with confirmed prior SARS-CoV-2 infection. Most participants were recruited during outpatient specialty consultations, with a smaller number included from hospital settings, all located in Bucharest. A structured questionnaire was administered by the principal investigator after obtaining informed consent. Quantitative data were analyzed using non-parametric methods following confirmation of non-normal distribution via the Shapiro–Wilk test (p < 0.05). Satisfaction scores were reported as medians with interquartile ranges (IQR), and group comparisons were performed using the Mann–Whitney U test. A mixed-methods approach was employed, including thematic analysis of open-ended responses. Results: Patient satisfaction with rehabilitation services was consistently low. The median satisfaction scores [IQR] were accessibility 1.0 [0.0–2.0], quality of services 0.0 [0.0–4.0], staff empathy 0.0 [0.0–5.0], and perceived effectiveness 0.0 [0.0–5.0]. The median score for perceived difficulties in access was 1.0 [1.0–2.0], indicating widespread barriers. No statistically significant differences were observed between urban and rural participants or across chronic disease categories. Thematic analysis (n = 65) revealed key concerns including lack of publicly funded services, cost barriers, limited physician referral, service scarcity in rural areas, and demand for home-based rehabilitation options. Conclusions: Romanian patients with chronic illnesses and previous SARS-CoV-2 infection continue to face substantial barriers in accessing post-COVID-19 rehabilitation services. These findings highlight the need for more equitable and integrated recovery programs, especially for vulnerable populations in underserved settings. Full article

Background/Objectives: Increasing evidence has shown that terminal cancer patients experience a poor quality of life (QoL), but the complex internal structure of the QoL among terminal cancer patients is not well documented. This study aimed to explore the core attributes of QoL and their interrelationships in low-income terminal cancer patients stratified by survival time (<3 months vs. 3–6 months). Methods: This study retrospectively analyzed the records of 5649 low-income terminal cancer patients from a hospital hospice center. The Cancer Pain and Quality of Life Questionnaire for Chinese Cancer Patients (CPQLQ) was employed to assess the QoL. A network analysis was conducted to examine centrality indices and density measures. Results: For patients with a survival time of 3 to 6 months, the highest centrality score was associated with “attitudes towards treatment” of the CPQLQ (rs = 1.84). In contrast, for those with a survival time of less than 3 months, “illness perception” of the CPQLQ had the highest centrality score (rs = 1.70). In both the less than 3 months and 3–6 months survival time groups, the network analysis indicated that the strongest correlations were between “illness perception” and “attitudes towards treatment” of the CPQLQ. Conclusions: Attitudes towards treatment and illness perception emerge as core attributes of the QoL network and are strongly interrelated among low-income terminally ill cancer patients. The findings highlight that a shift in hospice care priorities, linked to survival time, is crucial for enhancing the QoL of terminal cancer patients. Full article

Background/Objectives: Persistent breathlessness impacts people living with advanced chronic obstructive pulmonary disease (COPD) and carers. Accessible services are limited. This translational pilot study evaluated the feasibility, impacts on patient and carer-reported outcomes, and hospital use of a home-based breathlessness intervention service (BLIS). Methods: People with stable COPD, ≥1 COPD-related hospital admissions in the previous year, and persistent breathlessness participated in a pre–post study. The BLIS program involved home visits/phone contacts by a nurse/physiotherapist (average 8 contacts, 7 weeks). Uptake, retention, and fidelity were recorded prospectively, and participant experience was explored (post-program interviews). Breathing discomfort (Multidimensional Dyspnea Profile A1 scale), threat (Brief Illness Perception Questionnaire), and carer stress/strain (Zarit Burden Interview) were compared pre- and post-program (week 9, 3 and 6 months) using mean difference and 95% confidence intervals (CIs). Hospital use for COPD-related causes in 12 months before/after participation was reported. Results: A total of 16/19 eligible people agreed to participate, and 15/16 completed the program. In participants with COPD (73 [9] years, FEV1%pred 42% [15], mean [SD]; a median of 3 COPD-related hospital admissions in the previous year) and carers (n = 6), BLIS was highly (in 95%) acceptable. Compared to pre-program, breathing discomfort was reduced in week 9 and 6 months; breathlessness threat was reduced in week 9 and 3 months; and carer burden was reduced at 6 months. Compared to the 12 months prior, hospital admissions decreased in the 12 months post-program. Conclusions: Translation of this service to the local setting was feasible, with high program uptake and retention. Post-program improvements in key patient- and carer-reported outcomes and a reduction in public hospital admissions support the implementation of the BLIS program for this cohort in this setting. Full article

Background/Objective: Early mobilization (EM) of critically ill patients is a feasible and safe intervention that limits the implications of bed rest and improves lung function. However, its limited implementation suggests a gap between the research evidence and clinical practice. It is widely accepted that early mobilization faces a variety of barriers. This study aimed to investigate the perceptions of Greek physiotherapists on EM barriers and record their knowledge and practices. Methods: We conducted an electronic survey using the online platform “Microsoft Forms”, among critical care physiotherapists in 66 hospitals that had an Intensive Care Unit (ICU) department in Greece in 2024. We administered a questionnaire, developed based on valid and reliable international questionnaires, with the following domains: education and knowledge on early mobilization, practices, perception regarding EM, and perceived barriers to early mobilization. Results: A total of 126 Greek physical therapists participated. The majority of them worked in urban area hospitals and in a rotation schedule around all departments. Most physical therapists stated that early mobilization is a priority for the patient’s rehabilitation and an important factor in preventing the complications of bed rest. Yet, they do not use specific protocols. Most had knowledge of what EM involved and the international guidelines. The most common barriers reported were the hemodynamic instability and the incoherence with the ventilator. Dedicated physiotherapists singled out certain barriers like the presence of delirium and the lack of communication among ICU staff. Additionally, physiotherapists with more years of experience did not acknowledge tubes, connections, femoral lines and Body Mass Index (BMI) as barriers. Conclusions: Most Greek physiotherapists believe that early mobilization is crucial for the rehabilitation of critically ill patients. A significant percentage know the guidelines, yet they do not follow a specific protocol. Various barriers prevent its implementation, which depends on the patients, healthcare providers, and the overall process. Yet, It is recognized that practices and perceived barriers are influenced by experience and work schedule. Establishing clinical protocols is essential to facilitate the implementation of early mobilization and support patient rehabilitation. Future efforts should focus on designing strategies and EM protocols for physiotherapy in Greek ICUs. Also, we need to monitor changes in perceived barriers across other countries as focus on the matter via published studies and clinical seminars could lead to significant changes. Full article

Introduction: Longevity is increasingly recognized as the result of modifiable lifestyle, environmental, and social factors rather than genetics alone. While global interest in healthy aging is growing, public awareness of these determinants remains understudied in the Middle East. This study aimed to assess public awareness and perceptions of longevity-related factors among adults in Saudi Arabia. Methods: A cross-sectional online survey was conducted between November 2024 and January 2025 targeting residents of Saudi Arabia aged 18 and above. A researcher-validated questionnaire explored awareness across various domains, including lifestyle, environment, genetics, sleep, and religious beliefs. Perceptions were assessed using a series of items measuring beliefs about the influence of lifestyle, environmental, technological, and cultural factors on health and longevity. Descriptive and inferential statistics were used to analyze responses from 395 participants. Results: The sample included 395 participants, with 67.8% females and more than half (51.4%) aged 18–25 years. The participants exhibited high awareness of key lifestyle factors; greater than 88% acknowledged the role of sleep, and more than 90% recognized the importance of exercise and nutrition. However, fewer were aware of environmental (72.2%) or social determinants, and nearly half believed that genetic factors exert a primary influence on longevity. Higher awareness was significantly associated with behaviors like regular exercise (p = 0.004), dietary supplement use (p = 0.002), and recognition of the importance of sleep (p < 0.001). Younger adults showed higher awareness than older adults, while there were no significant differences in regards to gender, education, and income. Support for incorporating religious themes into health campaigns was also linked to greater awareness. Insurance status and chronic illness were not associated with awareness levels. Conclusions: While awareness of lifestyle-related longevity factors is strong, gaps remain in understanding broader influences such as environmental and social determinants. Culturally grounded public health strategies that integrate religious framing and emphasize actionable, evidence-based behaviors may enhance community engagement and support healthy aging across Saudi Arabia. Full article

Aims/Background: Medical education is largely clinical and biomedical with little emphasis being put upon the social determinants of health (SDH) and patient-centredness. A programme entitled “Walking a Day in My Shoes” was devised as a pilot cohort study with the view of evaluating the impact of a clinical shadowing experience upon the empathy, SDH awareness, and patient-centredness of medical students. Methods: A prospective cohort study, involving 28 final-year London-area medical students, employing a three-phase teaching programme comprising preparation, observation, and reflection was carried out. Students’ confidence in the management of non-medical barriers, SDH awareness, and empathy before and after shadowing were measured using pre- and post-shadowing questionnaires. Qualitative analysis of patient feedback and journals also occurred. Results: Statistically significant improvements were observed in students’ empathy (mean score increase from 6.8 to 8.9, p < 0.001), understanding of SDH (advanced comprehension rose from 35% to 93%), confidence in addressing non-clinical barriers (from 39% to 86%), and awareness of logistical challenges (from 31% to 81%). Qualitative analysis highlighted key themes, including systemic barriers (transportation, polypharmacy, and social isolation) and students’ increased awareness of the emotional toll of chronic illness. Patients expressed high satisfaction, with 97% agreeing that the programme improved students’ understanding of chronic disease management. These findings suggest the programme’s practicality and scalability in medical education. Conclusions: This pilot cohort study demonstrated the significant enhancement of the students’ empathy, perception of SDH, and patient-centredness preparation through immersive shadowing. The findings support the use of experiential learning programmes as curricular interventions. Full article

Background/Objectives: As a peripheral effect of depression-related traits, sensory responses may predispose individuals to depressive symptoms by prompting suboptimal dietary patterns with long-term effects on mood. Mood disturbances in adolescence are strong predictors of adult mental illness, making it crucial to identify factors that may shift transient mood fluctuations into more severe mental health issues during this vulnerable period. Given the substantial gender differences in susceptibility to comorbidities of depression, we examined whether the link between sensory perception and depressive symptoms in nonclinical adolescents varied by gender and was related to dietary habits. Methods: In this cross-sectional study, 232 healthy adolescents (41.8% girls, aged 13–17) reported their diet over the past year using the EPIC Food Frequency Questionnaire and rated their liking and perceived intensity of oral sensations from four grapefruit juices and dark chocolate puddings with varying sucrose levels. Additionally, participants completed assessments of anxiety, neuroticism, pickiness, body dissatisfaction, and the Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Results: We found that girls exhibited higher levels of depression, anxiety, neuroticism, and pickiness compared to boys (Wilcoxon Rank Sum Test), and that greater responsiveness to bitterness (e.g., β = 0.264, p = 0.037) and astringency (β = 0.269, p = 0.029) predicted higher depressive symptoms exclusively in girls. PHQ-9 scores were positively associated with alcohol use in both girls (ρ = 0.176, p = 0.003) and boys (ρ = 0.148, p = 0.004) and inversely related to the intake of beneficial nutrients (e.g., fiber, polyunsaturated fats), particularly in girls. Intriguingly, moderation analyses suggested that associations between nutrient intake and acuity for alarming oral sensations were largely moderated by depression-related traits in girls, but not in boys. Conclusions: Our findings suggest that gender moderates the links between depressive symptoms, sensory perception, and dietary habits in healthy adolescents, possibly reflecting gender-specific coping strategies for comorbidities of depression. Full article

Goal Contents Theory (GCT) postulates that the goals people pursue not only direct their perceptions of and behaviors relevant to goal pursuit, but also hold implications for their well- and ill-being. Extending past sport work grounded in this theory, this study explored athletes’ self-generated goals and examined whether these goals were differentially aligned with goal-related processes and well- and ill-being. A total of 414 university team athletes (206 women and 208 men) completed a questionnaire at the beginning of the sport season. The results showed that intrinsic goals, assessed in an open-ended format, were more heterogeneous in terms of content, and more common among athletes than extrinsic goals. In addition, women reported more intrinsic goals and fewer extrinsic goals than men. MANCOVA revealed that athletes who pursued extrinsic goals reported significantly lower self-efficacy and greater perceptions of goal difficulty than athletes with intrinsic goals. No differences in goal motives and well- and ill-being indicators emerged. Finally, two models were tested that illustrate how goal content is related to self-efficacy for goal attainment, goal motives, and well- and ill-being. Overall, the findings were largely congruent with GCT and indicate that the quality of athletes’ goal-related processes and their well- and ill-being vary as a function of whether they are pursuing intrinsic or extrinsic goals. Full article

Background: Post-COVID-19 syndrome (PCS) is defined as the persistence of symptoms 3 months after acute SARS-CoV-2 infection. The long-term prevalence and clinical progression of PCS has not been established. Our aim was to investigate the symptoms in PCS patients, explore the degree of physical activity, according to the fatigue severity score, and analyze its association with basic cardio-pulmonary exercise testing (CPET) parameters. Methods: A total of 192 subjects with history of SARSCoV-2 infection were included. They filled in the Chronic Fatigue Syndrome Questionnaire (CFSQ) and were divided into symptomatic and asymptomatic groups. Forty-seven had persistent post-COVID complaints—reduced physical capacity, fatigue, dyspnea, sleep disturbances, muscle pain. CPET was performed and the pathophysiological parameters in the different fatigue severity groups were compared. Results: Subjects with persistent long-term PCS were divided into two groups—mild (20) and moderate–severe (27), depending on the CFSQ score; forty-eight PCS subjects without complaints served as a control group. The average period between the acute illness and the study was 1028 ± 214 days. Subjects with moderate–severe PCS had more symptoms during CPET (73.6% vs. 24.8% vs. 17.4%), as compared to mild/asymptomatic. The rate of perceived effort was subjective and did not correspond to the workload, heart, or breathing rate in the symptomatic group. These subjects were unable to reach the anaerobic threshold, compared to mild/asymptomatic subjects (51.8% vs. 25%, vs. 12.5%). Patients with moderate–severe PCS showed lower peak VO₂ (24.13 ± 6.1 mL/min/kg vs. 26.73 ± 5.9 mL/min/kg, vs. 27.01 ± 6.3 mL/min/kg), as compared to mild/asymptomatic subjects. Conclusions: Long-term PCS is still present in up to 24% of the general population, more than thirty months after the acute episode. It is characterized by increased perception of symptom burden and diminished aerobic metabolism. A third of the long-term PCS exhibit lower cardio-respiratory fitness, independently from the severity of the symptoms. Full article

Background: Although illness perception (IP) is a widely recognised factor in the psychosocial adjustment to cancer, little is known about the impact of individual dimensions of IP. This study aims to analyse the relationship between individual dimensions of IP and quality of life (QOL) in childhood cancer survivors. Methods: The sample consisted of 163 long-term survivors aged 11 to 25 who were administered the Brief Illness Perceptions Questionnaire and the Minneapolis–Manchester Quality of Life Scale. Results: In the correlational analysis, all dimensions of IP were associated with individual dimensions of QOL, except for understanding and treatment control. The results of the hierarchical regression analysis controlling for demographic and medical factors showed that IP had predicted individual dimensions of QOL above and beyond these factors, with emotional response, concern, consequences and understanding being the most predictive dimensions. Several age-specific relationships between IP and QOL were also identified. Conclusions: Illness perceptions significantly contribute to explaining QOL of childhood cancer survivors above and beyond demographic and medical factors. These results may contribute to more effective targeting of psychosocial interventions promoting QOL of survivors. Full article

Background/objectives: Chronic kidney disease (CKD) has become an important public health issue; however, there are few investigations regarding the perception of CKD in its advanced stages. Personalized medicine approaches, which take into account knowledge of the disease, symptoms and treatment responses, can improve the perception of the disease and help control the progression of CKD. This study aimed to describe illness perception in people with advanced CKD in primary healthcare settings. Methods: A cross-sectional and multicenter descriptive study was conducted amongst a sample of 189 people over 18 years of age with advanced CKD and a glomerular filtration rate between 15 and 29 mL/min/1.73 m² in three community health centers, including rural and urban areas, during 2023. Data on sociodemographic and clinical variables were collected through an ad hoc questionnaire and those on the perception of disease through the Brief Illness Perception Questionnaire. Nurses at the centers collected data from the study. Results: The mean age was 79.7, and all participants suffered from another chronic condition in addition to CKD. The mean total score for perception of the disease was 44.02 points, and the dimensions of the duration of treatment control and understanding had the highest evaluations. Men had a greater perception in the dimensions of concern (p = 0.023) and understanding (p = 0.006). The dimension of consequences showed a correlation with identity (Spearman’s Rho 0.688; p = 0.001), and concern about the disease was associated with emotional response (Spearman’s Rho 0.689; p < 0.001). A higher number of hospital admissions was associated with a higher score on the questionnaire (B = 4.93; p < 0.001; CI: 3.01–6.84) in a multiple linear regression. Conclusions: Participants in this study with advanced CKD had low illness perception; women expressed less concern in understanding their health status. Higher symptom burden was linked to greater illness perception, greater emotional impact, and increased hospital admissions. Full article